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Editorials

Rise in mortality in England and Wales in first seven weeks of 2018

BMJ 2018; 360 doi: https://doi.org/10.1136/bmj.k1090 (Published 14 March 2018) Cite this as: BMJ 2018;360:k1090

Re: Rise in mortality in England and Wales in first seven weeks of 2018

On 20th March 2018, speaking in the House of Commons, Dr Paul Williams MP referred to this editorial. He asked the Secretary of State for Health and Social Care, Jeremy Hunt, ‘why did all these extra deaths occur?’.1 Mr Hunt replied:

"As the hon. Gentleman will know, these figures cover England and Wales. He will also know that they do not take account of changes in population or changes in demography, so we use the age-standardised mortality rate, which, according to Public Health England, has remained broadly stable over recent years.1"

To take each point in turn, firstly, the Secretary of State is correct: these figures do cover England and Wales. However, this distinction is trivial. If the figures for weekly provisional deaths by ‘region of usual residence’ are used, the total for Wales is 5,841 for weeks 1-7 of 2018, and the average for the last 5 years 5166.2 England deaths, therefore, are 88,149 compared to a 5-year average, without Wales, of 78,449. This gives an extra 9,700 deaths in England. These Office for National Statistics (ONS) data are available to the Secretary of State and his advisors if they wish to know about trends solely in England.

Secondly, a change in population or demography does not happen suddenly. However, we agree it would be useful to examine the age-standardised mortality rate. Given the gravity of the concerns raised, we hope Public Health England will urgently calculate this, using the ONS projection of the population at risk in 2018,3 to compare what was expected in 2018 to what has been seen. We do not believe this will alleviate our concerns. The ONS projections do not include a sudden very large influx of elderly people, and there is no evidence that this has occurred.

Finally, last week saw publication of statistics not only raising the alarm at mortality rates in adults, but also in infants. Infant mortality has risen two years in a row.4 This confirmed the concerns first raised by Taylor-Robinson et al in 2017,5 and re-iterated in their rapid response.6 Among countries of the European Union, between 1990 and 2015 the UK dropped from 7th place to 19th for neonatal mortality, and from 9th to 19th for under-five mortality.7

Infant mortality is rising, life expectancy is stalling, and there have already been 9,700 extra deaths above what is usual in England in the first 7 weeks of 2018. This leaves us wondering—what will it take for the Government to investigate? We hope the Secretary of State for Health will significantly and urgently re-consider his response.

References:
1. House of Commons Hansard. Topical Questions, 20 March 2018. https://hansard.parliament.uk/commons/2018-03-20/debates/3E71DB83-CDBA-4... (accessed 21 March 2018)
2. Office for National Statistics. Weekly provisional deaths https://www.ons.gov.uk/peoplepopulationandcommunity/birthsdeathsandmarri... (accessed 21 March 2018)
3. Office for National Statistics. Principal projection – England and Wales Summary. 26 October 2017. https://www.ons.gov.uk/peoplepopulationandcommunity/populationandmigrati... (accessed 21 March 2018)
4. Office for National Statistics. Child mortality in England and Wales: 2016. 14 March 2018. https://www.ons.gov.uk/peoplepopulationandcommunity/birthsdeathsandmarri... (accessed 21 March 2018)
5. Taylor-Robinson D, Barr B. Death rate now rising in UK's poorest infants. BMJ (Clinical research ed) 2017;357:j2258. doi: 10.1136/bmj.j2258 [published Online First: 2017/05/13]
6. Taylor-Robinson D, et al. Death rate continues to rise for poorest infants in England and Wales. BMJ 2018;360:k1090
7. Office for National Statistics. UK drops in European child mortality ranks. 13 October 2017. https://visual.ons.gov.uk/uk-drops-in-european-child-mortality-rankings/ (accessed 21 March 2018)

Competing interests: No competing interests

21 March 2018
Lucinda Hiam
Honorary research fellow and NHS GP
Danny Dorling (Halford Mackinder professor of geography, University of Oxford)
London School of Hygiene and Tropical Medicine